Author Affiliation: Dr Salzman is Professor of Psychiatry, Harvard Medical School, and Director of Education and Director of Psychopharmacology, Massachusetts Mental Health Center, Boston, Mass.
Clinical Crossroads at Beth Israel Deaconess Medical Center
is produced and edited by Thomas L. Delbanco, MD, Jennifer Daley, MD,
and Richard A. Parker, MD; Erin E. Hartman, MS, is managing editor.
Clinical Crossroads section editor: Margaret A. Winker, MD, Deputy
DR PARKER: Ms B is an
87-year-old woman who has taken benzodiazepines for at least 15 years.
Her physician is trying to weigh the risks and benefits of continuing
her therapy with alprazolam or attempting to taper it off. Ms B lives
alone and independently near Boston, Mass, and has her health insurance
Ms B describes anxiety symptoms occurring since at least young
adulthood. She speaks of "worry about illness in family members,"
generalized uncomfortable anxiety, "low mood" without clear
depressive symptoms, and a "hard life" with few breaks. Her affect
is flat, her mood sad, and her thoughts pessimistic. "I've never had
joy in my life—just tried to get through day by day." She has always
been single. She attributed her inability to succeed in relationships
with men to her hysterectomy, which made her unable to bear children.
She derives pleasure from playing the piano, but she has little
motivation to seek interpersonal contact or pleasurable activities. She
has never presented with a frank clinical depression.
Salzman C. An 87-Year-Old Woman Taking a Benzodiazepine. JAMA. 1999;281(12):1121-1125. doi:10.1001/jama.281.12.1121